Rx Savings Guide A helpful handbook for understanding your Medicare Advantage prescription drug plan and saving money

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Your doctor can help you save money – here’s how Take these four things with you to your next appointment:

1 Your personal drug list: A list of all medications you’re currently taking, including any supplements.

Your personal drug list provides your doctor with a complete overview of what you’re taking. While supplements aren’t covered by your prescription drug plan, they should still be included on this list.

2 The Blue Care Network drug list: The Blue Care Network formulary (or drug list) is updated for the upcoming plan year every fall. You can see it online at bcbsm.com/formularymedicare.

The Blue Care Network drug list is specifically tailored to your plan. Having a copy on hand allows your doctor to make an informed decision about what drugs are available and any necessary requirements before writing a prescription.

3 This guide: Your cost-share chart on Page 9 is a helpful resource for your doctor.

This chart can help your doctor make the most cost-effective choice for your medication.

4 Your retail or mail-order pharmacy contact information: By bringing the name, address and phone number of your chosen pharmacy, you can help ensure that your prescriptions are filled quickly.

Your prescriptions will cost less at a preferred pharmacy. You also have the option of getting a 31-day or 90-day supply of your recurring medication.

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Take these four things with you to your next appointment:

What’s the best and most cost-effective medication for me? Why is this question important? When your doctor understands what your plan covers, they can best choose safe, effective and less expensive medications.

Many medications effectively treat similar conditions, so your doctor may be able to prescribe medications that cost less.

Ask your doctor one question:

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There’s an easy way for you to savemoney on your prescriptions

Costco Pharmacy D & W Pharmacy Family Fare Pharmacy Kmart Pharmacy Kroger Pharmacy Meijer Pharmacy

Rite Aid Pharmacy Sam’s Club Pharmacy VG’s Pharmacy Walgreens Pharmacy* Walmart Pharmacy

*Walgreens is a preferred pharmacy for retail only.

CVS is a standard pharmacy.

This list is subject to change and doesn’t include preferred chains or independent pharmacies that participate outside of Michigan.

Independent pharmacies may also be preferred. Be sure to check if you use one.

Preferred chain pharmacies in Michigan

Use a preferred retail or mail-order pharmacy Preferred pharmacies have a partnership with Blue Care Network to provide savings to our members. If a pharmacy isn’t preferred, it’s considered standard.

Choosing a preferred pharmacy can save you money on both 31-day and 90-day prescriptions.

Other pharmacies are available in our network.

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When searching, preferred pharmacies come up first and are clearly marked as shown below.

PHARMACY A 0.63 mi 123 MAIN ST ANY TOWN, MI–34567-8910 COUNTY: MACOMB 313-555-5555

Preferred pharmacy

It’s easy to find a preferred pharmacy: •

Give us a call at the number on the back of your member ID card.

• Visit www.bcbsm.com/pharmaciesmedicare.

• Log in to your member account at www.bcbsm.com.

Transfer your prescriptions with just one call: Call your new preferred pharmacy and let them know you’d like to transfer your prescriptions.

After that, your new preferred pharmacy will handle the transfer.

Prefer mail order? There are two choices available This option works best for medications you take regularly. Place your order at least two weeks before your medication runs out to make sure you aren’t without it. Mail order isn’t suggested if you need your medications right away.

Express Scripts AllianceRX Walgreens Prime (preferred) Home Delivery (standard) Call: 1-877-801-2332 Call: 1-866-877-2392 TTY users, call 1-800-716-3231 TTY users, call 1-800-573-1833 24 hours a day, seven days a week 24 hours a day, seven days a week www.express-scripts.com www.alliancerxwp.com/home-delivery

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The first step is to see what tier your new or current prescription drug is in.

How? That’s easy. Each drug is listed alphabetically in the Index at the back of the Blue Care Network drug list. Each drug is assigned a Tier, 1 through 6.

You can view it online at bcbsm.com/formularymedicare.

Be sure to select the 2020 BCN Advantage Comprehensive Formulary under the BCN AdvantageSM HMO-POS and HMO plans section.

How much will my drugs cost me this year?

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1

2

4

5

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Understanding your drug tiers

Drug Tier Description

Preferred Generic These are generic drugs in the lowest cost-sharing tier.

Generic These are still generic drugs but not the lowest cost-sharing tier.

Preferred Brand This tier contains mostly brand-name drugs and also includes some high-cost generics.

Non-Preferred Drug These are brand and generic drugs not in a preferred tier.

Specialty Drugs This contains high-cost generic and brand-name drugs (the highest tier).

Select Care Drugs This is a $0 copay tier at preferred in-network pharmacies.

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Here’s how it works for your plan, HealthyValue: Ollie has a new prescription for atenolol. Ollie flips to the Index at the back of the Blue Care Network drug list and finds the page for atenolol. Turning to that page, Ollie sees it’s a Tier 1 drug.

Next, Ollie checks the cost-share chart (on the next page). Ollie sees that under Initial Coverage, a Tier 1 drug atenolol will only cost $2 for a 31-day supply or $6 for a 90-day supply at a preferred retail or preferred mail-order pharmacy. Since the doctor wants Ollie taking atenolol for the next six months, mail order looks like a convenient option for him.

If Ollie’s drug had been in Tier 3, 4 or 5, then Ollie would have paid the full cost (100%) of the drug, which would be applied toward the $250 Deductible. However, as soon as

Cost-share stages

Ollie meets his Deductible, Ollie begins paying the Initial Coverage amounts for all drugs, so a Tier 3 drug would be $42 at a preferred pharmacy or $47 at a standard pharmacy.

For the rest of the year, Ollie’s costs would only change if the total drug spend by Blue Care Network and Ollie exceeded $4,020. Then Ollie would move from Initial Coverage to the Coverage Gap (sometimes called the Donut Hole). Once in the Coverage Gap, for tiers one through five, Ollie would pay 25% of the cost of his drug if it was a generic or a brand-name drug. For tier six, Ollie would have a $0 copay at a preferred pharmacy, or a $5 copay at a standard pharmacy for a 31-day supply.

However, if Ollie’s total spend for his prescriptions and deductible exceeds $6,350, he would enter Catastrophic Coverage. Then, for all tiers, he would only pay the greater of 5% or $3.60 it’s was a generic, or the greater of 5% or $8.95 if it’s a brand-name drug.

Initial Coverage Coverage Gap (Donut Hole)

Catastrophic Coverage

You paid + plan paid = $4,020 Most people don’t go beyond Initial Coverage.

You paid = $6,350 Plan year ends

To see how much you and your plan have spent:

• Sign in to your member account at www.bcbsm.com/medicare.

• Give us a call at the number on the back of your member ID card.

• Log in to your member account with the BCBSM mobile app.

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BCN Advantage HealthyValue HMO 2020 Cost Sharing

Cost-share chart What you’ll pay for a 31-day supply

Drug Tier

1

2

3

4

5

6

Initial Coverage Coverage Gap (Donut Hole)

Catastrophic Coverage

Preferred pharmacy $2

Standard pharmacy $8

• Generic 25%

• Brand name 25%

• Generic the greater of 5% or $3.60

• Brand name the greater of 5% or $8.95

Preferred pharmacy $11

Standard pharmacy $20

• Generic 25%

• Brand name 25%

Deductible

Preferred pharmacy $42

Standard pharmacy $47

• Generic 25%

• Brand name 25%

Preferred pharmacy 50%

Standard pharmacy 50%

• Generic 25%

• Brand name 25%

Preferred pharmacy 28%

Standard pharmacy 28%

• Generic 25%

• Brand name 25%

Preferred pharmacy $0

Standard pharmacy $5

Preferred pharmacy $0

Standard pharmacy $5

This plan offers additional coverage for Tier 6: Select Care Drugs when you reach the coverage gap. This means that you continue to pay $0 at a preferred pharmacy for these medications.

Using preferred pharmacies means lower copays In 2020, if Lulu uses a preferred pharmacy, a Tier 1 drug will only cost her $2.

However, if Lulu uses a standard pharmacy, the same drug will cost $8 for a 31-day supply. So, Lulu would spend $72 more per year than necessary.

Cost-sharing terms you may hear Copayment (or copay) – A fixed amount that you pay each time you fill a prescription. Your plan pays the remainder of the cost.

Coinsurance – A percentage of the cost of the drug that you pay each time you fill a prescription. Your plan pays the remainder of the cost.

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Understanding yourdrug supply options Your choice: 31-day or 90-day supply You have the flexibility to choose a 31-day or 90-day supply of your medication. Choosing a 90-day supply means fewer trips to the pharmacy and less chance you’ll run out of your medications. Additionally, members who receive a 90-day supply of a medication are 20% more likely to take their medication as prescribed compared with members receiving a 31-day supply. You have the option to get a 90-day supply of your medications at a pharmacy or through mail order. Using a preferred retail or mail-order pharmacy will give you the lowest cost.

Why it’s important to follow your doctor’s orders When you take your medications regularly, not only will your doctor be better able to manage your care, doing so will help keep you healthy and may also lower your risk of heart attack, stroke, kidney disease, eye and nerve damage and other illnesses.

Always let your doctor or pharmacist know if you have any trouble or concerns about taking your medications regularly.

Traveling? Plan ahead IWhen you travel, talk to your doctor about a 90-day supply. It’ll help you stay healthy and ensure you’re following your doctor’s treatment plan while you’re away from home.

Suddenly need a prescription? You can find a preferred pharmacy: • At www.bcbsm.com/pharmaciesmedicare • By logging into your member account at

www.bcbsm.com • On the BCBSM mobile app • By calling the Customer Service number on the

back of your member ID card

Did you know? It’s easy to use your prescription drug plan. You can even save money on a 31-day supply by filling your prescription at a preferred pharmacy.

A 90-day supply is the same price at the pharmacy or by mail order — three times the price of a 31-day supply (90‑day supply isn’t available for Tier 5).

You’ll pay the lowest amount for your prescriptions if you choose a preferred retail or mail-order pharmacy. To ensure you’re paying the lowest cost for your medications, remember to always show your member ID card at the pharmacy.

Does my plan cover the newest medications? Blue Care Network always adds treatment options to our Blue Care Network drug lists throughout the year.

We work with a team of pharmacists and physicians to review new medications and update our drug lists accordingly.

We update our drug list during the current year, and annually, as the government approves, restricts or recalls medications. These adjustments are made to keep you safe, introduce new treatment options and keep your costs down.

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Resources for Blue Care Network members

Help paying for your prescription drugs Aside from contributing to your long-term health, taking your medications as prescribed by your physician is important for controlling chronic diseases and treating temporary conditions. By taking your medications as directed, hospitalizations, hospital readmissions and disease progression can be slowed or prevented. If you’re struggling to pay for your prescription drugs, the resources below may help you.

Medicare “Extra Help” Medicare provides the Extra Help program to pay prescription drug costs for people with limited income and resources.

If you qualify, you get help paying for any Medicare drug plan’s monthly premium, yearly deductible and prescription copayments. Extra Help also counts toward your out-of-pocket costs.

Call one of the options below Blue365 member to see if you qualify: discount program* Medicare This program helps you find health and wellness 1-800-MEDICARE (633-4227) information and services year-round, including: TTY users, call 1-877-486-2048 • Financial planning 24 hours a day, 7 days a week • Weight loss programs Social Security • Travel discounts 1-800-772-1213 • Gym membershipsTTY users, call 1-800-325-0778 7 a.m. to 7 p.m. • Healthy eating Monday through Friday • Personal care

Your state Medicaid office It also provides special member 1-855-789-5610 savings and access to content, tools 8 a.m. to 7 p.m. Eastern time and discount offers available through Monday through Friday www.bcbsm.com/discounts.

*This is not a plan benefit. Blue365 offers If you need assistance applying for Extra access to health and wellness deals exclusiveHelp, call BCN’s My Advocate program to Blue members.at 1-866-631-5967 (TTY 1-877-644-3244),

Monday through Friday, 9 a.m. to 6 p.m.

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BCN Advantage

Michigan nondiscrimination short notice and language assistance taglines for significantpublications and significant communications that are small-size.

• The shortened non-discrimination statement is for Michigan tri-fold brochures andpostcards.

o Runs in English onlyo Do not add a logo. The document logo is sufficient.o Font should be Times New Roman, 12 pt., or the equivalent, which is a CMS MA

rule.

• The language assistance taglines are in Spanish and Arabic for Michigan tri-fold brochures and postcards.

o Arabic reads from right to left so that tagline should be flush right. The phonenumber can read from left to right. Copy and paste the Arabic as an image toprevent characters from moving oddly. If you have questions about this, contactRobin Larkin.

o Do not include English.o Do not include a headline or logo.o Do not label the language – the name of the language is already in each tagline.o Font should be Times New Roman, 12 pt., or the equivalent, which is a CMS MA

rule.

Blue Care Network complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1-800-450-3680 (TTY: 711).

BCN Advantage

Michigan nondiscrimination short notice and language assistance taglines for significantpublications and significant communications that are small-size.

• The shortened non-discrimination statement is for Michigan tri-fold brochures andpostcards.

o Runs in English onlyo Do not add a logo. The document logo is sufficient.o Font should be Times New Roman, 12 pt., or the equivalent, which is a CMS MA

rule.

• The language assistance taglines are in Spanish and Arabic for Michigan tri-fold brochures and postcards.

o Arabic reads from right to left so that tagline should be flush right. The phonenumber can read from left to right. Copy and paste the Arabic as an image toprevent characters from moving oddly. If you have questions about this, contactRobin Larkin.

o Do not include English.o Do not include a headline or logo.o Do not label the language – the name of the language is already in each tagline.o Font should be Times New Roman, 12 pt., or the equivalent, which is a CMS MA

rule.

Blue Care Network complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

برقماتصل.بالمجانلكتتوافراللغویةالمساعدةخدماتفإن،العربیةتتحدثكنتإذا: ملحوظة711).:والبكمالصمھاتفرقم(1-800-450-3680

BCN Advantage

Michigan nondiscrimination short notice and language assistance taglines for significantpublications and significant communications that are small-size.

• The shortened non-discrimination statement is for Michigan tri-fold brochures andpostcards.

o Runs in English onlyo Do not add a logo. The document logo is sufficient.o Font should be Times New Roman, 12 pt., or the equivalent, which is a CMS MA

rule.

• The language assistance taglines are in Spanish and Arabic for Michigan tri-fold brochures and postcards.

o Arabic reads from right to left so that tagline should be flush right. The phonenumber can read from left to right. Copy and paste the Arabic as an image toprevent characters from moving oddly. If you have questions about this, contactRobin Larkin.

o Do not include English.o Do not include a headline or logo.o Do not label the language – the name of the language is already in each tagline.o Font should be Times New Roman, 12 pt., or the equivalent, which is a CMS MA

rule.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1-800-450-3680 (TTY: 711).

برقماتصل.بالمجانلكتتوافراللغویةالمساعدةخدماتفإن،العربیةتتحدثكنتإذا: ملحوظة711).:والبكمالصمھاتفرقم(1-800-450-3680

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iPhone® or iPad®

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by logging in to your member• Go to the Google Play Store

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Blue Care Network complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-450-3680 (TTY: 711).

قمرب صلتا .نجاملبا لك فراوتتةیوغالل ةدعاسمالتامخد إنف،ةربیعلاثحدتتتكن ذاإ : ةظوحلم.)711:مكبوال صملا فتھا قمر( 1-800-450-3680

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